CV ABD Emergencies Flashcards
Evaluation of chest pain:
-classify patients into these three categories
Categories:
- chest wall pain
- pleuritic or resp chest pain
- visceral chest pain
Tx of SVT
Start with vagal maneuvers if the patient is stable. Give adenosine, if this doesnt work synchronized cardioversion.
Aortic Dissection
- causes
- presentation
- management
Causes:
- HTN ***
- atherosclerosis
- vasculopathies
- marfans
- congenital defect
Presentation:
- abrupt and severe pain in the anterior
- pain is described as ripping or tearing
- HTN and tachycardia
- Aortic regurgitation
Management:
- stabilize the patient; O2, IV, EKG, CXR, CT w/ contrast, TEE*, MRI, palpate pulses in all 4 limbs
- HTN control –medications w/ negative inotropic effects–labetalol, metoprolol, esmolol IV
- -may need some vasodilators–Nitroprusside IV (worry about Cyanide posioning)
- -stabilization and rapid referral to surgeon
Acute Pulmonary Edema:
- causes
- sx
- dx
- tx
Cause:
- increased hydrostatic pressure in the lungs(from the left side of the heart)
- increased oncotic pressure in the lungs (albumin too low)
- ARDS (leaky capillaries from sepsis)
Sx:
- severe resp distress
- cool skin
- rales
- JVD
- peripheral edema may or may not be present.
Dx:
- CXR**: dilated upper lobe vessels, cardiomegaly, interstitial edema, enlarged pulmonary artery, pleural effusion, alveolar edema, kerley B lines
- EKG
- CMP, CBC, cardiac enzymes, ABG
Tx:
- IV nitroglycerine to control BP, may need nitroprusside
- Diuretics = Furosemide
- Morphine IV
- Admit to ICU
What is the peritoneum?
Define acute abdomen
membrane that covers the surface of the organs that lie in the abdominal cavity. When this becomes infected it is called peritonitis.
Acute abdomen: an intra-abdominal process causing severe pain requiring admission to the hospital, which has not been previously investigated or treated and may need surgical intervention.
Possible etiologies of the acute abdomen in each of the following ages:
- children
- adult
- adult female
- elderly
Children:
- gastroenteritis
- meckels diverticulitis
- intussusception
Adults:
- regional enteritis
- kidney stone
- perforated ulcer
- testicular torsion
- pancreatitis
Adult female:
- PID
- pyelonephritis
- ectopic pregnancy
Elderly:
- diverticulitis
- intestinal obstruction
- colon carcinoma
- Mesenteric infarction
- Aortic Aneurysm
Acute Abdomen:
-sx
sx:
ONSET
-may be sudden –perforation of bowel, smooth muscle colic
-may be insidious–inflammation of visceral peritoneum
CHARACTER
- burning
- stabbing
- gripping/cramping
PROGRESSION
- constant
- colicky
- dull & poorly localized
- sharp (indicates involvement of parietal peritoneum)
RADIATION:
- back (duodenal ulcer, pancreatitis, aortic aneurysm
- scapula (gallbladder)
- sacroiliac region (ovary)
- groin (Testicular torsion)
PE findings of the Bowel Sounds:
- what is indicated if you hear:
- -silent abdomen
- -increased bowel sounds
silent abdomen: peritonitis, ileus
Increased bowel sounds: intestinal obstruction
Which lab test is pathoneumonic for pancreatitis?
Acute Appendicitis:
-typical presentation
What is Mcburneys point?
Amylase, this will be high in acute pancreatitis.
Typical presentation: periumbilical pain that migrates to RLQ
McBurneys point: where the appendix attaches to the cecum. it is 1/3 the distance between the ASIS and umbilicus
What types of Xrays are indicated for Abd pain?
What are the 4 cardinal signs of intestinal obstruction?
Chest, supine abdomen, erect abdomen (air-fluid levels), left lateral decubitus abd (substitute for erect chest/abd if pt cant sit/stand)
4 cardinal signs of intestinal obstruction:
- abd pain w/ intermittent cramping
- vomiting
- distension
- constipation
Acute Mesenteric ischemia:
- usually caused from an occlusion located where?
- tx
Chronic Mesenteric Ischemia:
- risk factors
- MC signs
- dx
Acute:
-usually caused from an acute occlusion of the SMA from thrombus or embolism
Tx: possible embolectomy
Chronic:
-risk factors: smoker, vasculopath with severe atherosclerotic vessel dz (low flow state)
MC sign is weight loss, temporalis muscle wasting b/c they stop eating d/t the pain.
Dx:
-CTA (angiography)
What does FAST stand for? How much fluid can FAST detect?
Does FAST replace CT?
Focused Assessment with Sonography for Trauma
Can detect 100ccs of fluid.
Only at the extremes, if the patient is unstable you would do FAST over CT. CT is more sensitive than FAST for detecting and characterizing abd injury and trauma.
Can you use Barium in an acute GI bleed?
WHat is the MC cause of BRBPR?
NO!!!! there may be a perforation and you dont want to make matters worse.
BRBPR is hemorrhoids Most commonly.
